Item 5 is a statement by the Minister for Health and Social Services: A Healthier Wales—an update on the 'Train. Work. Live.' campaign. And I call on the Minister for Health and Social Services, Vaughan Gething.

Thank you, Deputy Presiding Officer. The Welsh Government is committed to providing the NHS workforce that we need to ensure the best outcomes for people receiving care. We are achieving this with increased training places, encouraging young people to take up a health professional career, and supporting recruitment through our successful 'Train. Work. Live.' marketing campaign. The 'Train. Work. Live.' campaign is continuing to market NHS Wales healthcare careers alongside the lifestyle opportunities available in Wales. That's been marketed both within the UK and, of course, internationally.

What started as a campaign focused on promoting the benefits of working in general practice in Wales has, over the last three years, expanded to include a range of other key professions—nursing, psychiatry, pharmacy and most recently midwifery. The campaign is creating a positive view of Wales and what we can offer to healthcare professionals. This year I personally attended the Royal College of Nursing and the Royal College of Midwives conferences, seeing first-hand the positive response to our presence at these major events and the interest that that generated. Next year 'Train. Work. Live.' will showcase at the RCN and the RCM events as part of the international year of the nurse and midwife. With the RCM event, it will take place for the first time here in Wales. The campaign has also been key to establishing links with healthcare systems outside of the UK, and work is under way to develop a co-ordinated approach to international recruitment for nurses.

General practitioner training has remained a key focus for the campaign. Following the considerable success in filling places since 2016, I agreed an increased baseline allocation from 136 to 160 places, starting this autumn. This reinforces this Government’s commitment to delivering the workforce we need following record levels of doctors choosing Wales for their GP training.

This year we achieved the highest fill rate ever, filling 186 places from the allocation of 160, surpassing even that increased new allocation, with every training scheme across Wales filling to capacity, including those historically hard to recruit to areas. This includes, for example, the Pembrokeshire scheme, which had a zero fill rate as recently as 2016. This year, following all rounds of recruitment, Pembrokeshire now has filled seven places. The three north Wales schemes filled 28 places from their initial target allocation of 22 places.

Health Education and Improvement Wales is continuing work to ensure that the infrastructure is in place to support an increased number of GP trainees, with a view to a further expansion of the training schemes over the next two years. The sustained improvement in the recruitment position has been achieved by setting realistic targets about what can be delivered and extending our ambition incrementally as the system developed the capacity to deliver those additional numbers.

The campaign has also promoted other medical specialities that have seen increases in their fill rates. The fill rate for core psychiatry training has increased from just 33 per cent to 100 per cent in two years. That is another positive outcome. Despite the ongoing difficult financial climate, we continue to invest in the long-term sustainability of our NHS workforce, which continues to grow year on year.

For the sixth consecutive year, funding to support health professional education and training in Wales will increase. I made the decision to invest £127.8 million in 2020-1. That equates to a 13 per cent annual increase, with an extra £16.4 million for education and training programmes for healthcare professionals here in Wales. That includes £1.4 million for 47 additional medical postgraduate training places. That means that, since 2014, nurse training places have increased by 89 per cent, midwifery training places have increased by 71 per cent, physiotherapist training places have increased by 71 per cent as well, and radiography training places have increased by 57 per cent.

This is a record level of funding and will support the highest ever number of training opportunities in Wales. It increases the capacity of our workforce to help the NHS respond to the challenges facing it now and in the future. I am proud of this Government's record on investment. In the teeth of a decade of austerity, the NHS has more people working in it than at any time in its history, all aimed at prevention and care for people across each and every community here in Wales.

In addition to recruitment and training, retaining the existing workforce is key to securing a skilled and sustainable workforce. That is why the well-being of staff was central to our vision set out in 'A Healthier Wales' and will be part of the workforce strategy being jointly developed by Health Education and Improvement Wales and Social Care Wales.

I was pleased to announce last week the extension of the NHS Wales bursary until 2023. The bursary will be available for an additional two cohorts for the 2021-22 and 2022-23 academic years. It will be available to nurses and midwives, but, unlike Scotland, we will continue to provide the bursary to allied health professionals too. This announcement provides clarity on bursary arrangements for the next three academic years to both students and providers.

It is essential that we engage our next generation of healthcare professionals at all stages in their education. The supporting medical careers programme aims to increase the number of successful applications from Welsh speakers to medical schools in Wales, and I have extended this for a further year. Following the success of the 2018 programme, I agreed the scheme would run for a second year in 2019. Of the 60 students who attended the programme in 2018, 43 enrolled on health-related courses in Wales—28 to medicine and 15 to non-medical courses.

In addition to this, I have agreed a further one-year extension to the widening access to GP practice through work experience programme. The programme, which is now in its fourth year, is aiming to give year 12 students an opportunity to see the work involved in general practice. To date, over 200 students from across Wales have successfully taken part in the programme.

This year, we've also have introduced three key tools to inform a more holistic approach and support effective workforce planning in primary care: an all-Wales register for locum GPs, a national workforce reporting system to capture staff information in general practice, and a streamlined website for GP practices to manage and advertise vacancies.

Work is also continuing through the strategic programme for primary care to identify future priority areas for the 'Train. Work. Live.' campaign, including allied health professionals, who are of course a key part of the workforce. The allied health professions framework, 'Looking Forward Together', was launched at the national primary care conference on 7 November. The framework was developed collaboratively with members of the professions and a number of stakeholders.

The purpose of the framework is to ensure that citizens achieve outcomes that matter to them and experience the highest quality of care and treatment at all times. It provides a clear direction for transforming the way in which allied health professionals are used and accessed. In particular, it will help support the shift of allied health professionals into directly accessible primary and community care based services. This is consistent in delivering our national vision to provide care closer to home, to improve population health and well-being, and to maximise recovery that enables people to live as independently as possible for as long as possible.

The framework is supported by an action plan to drive change. One of the actions already implemented is the appointment of a national allied health professionals lead for primary care in the strategic programme for our primary care team. I look forward to taking questions today, and, of course, in the future. 

Good afternoon, Minister, and thank you for today's statement and for the advance sighting of it. I think there are some very good signs being shown in the 'Train. Work. Live.' campaign, and I especially welcome the efforts to improve the recruitment of young people and to increase the training places across all the healthcare professions. 

Now, one of the aims was to attract a more diverse demographic into the profession. A campaign was launched at the beginning of this year, featuring Richard Desir, as a male nurse, to try to attract more than the 12 per cent of male nurses we currently have, and I wondered if you could outline how this campaign is progressing and whether more male nurses have been recruited and whether in fact nurses have been recruited from a better or wider spread of ages. Additionally, could you outline whether or not there have been any successes in attracting nurses back into the profession who have previously left?

Now, I'm sure you will know the Royal College of Nursing has outlined there are severe gaps in the nursing workforce, noting that, every week, nurses in Wales give the NHS extra hours to the value of 976 full-time nurses. Now, last year, 2018-19, NHS Wales spent over £63 million on agency nursing, which is a rise of some 24 per cent from last year, and that's the equivalent of over 2,600 newly qualified nurses. Now, I do acknowledge the recent announcement of more nursing training places, but it is a question about whether or not those additional training places would actually cover that level of vacancy rates over the long term, and I wonder if you can give us a view for your anticipation for how that shortage in nurses would be covered and how long you may think it would take to do so.

Last week, the Scottish Government launched their 'What did you do today?' campaign to recruit more health staff, and I would like to know if you've had any discussions with your Scottish counterparts surrounding their attempts to make health a more attractive career path for young people, and is there anything we might learn from them. 

I'm very pleased to hear that specific areas of GP recruitment have been a success, particularly—and I'm highly partisan, as you'll probably know—the Pembrokeshire area, but are there any plans to expand this further, focusing specifically on other counties or other particular areas? Because, whilst these new training places are good news, I do remain concerned about the ability of Welsh health boards to retain existing GPs. Figures from the Royal College of GPs highlight that 31 per cent of GPs say that they are very stressed and they cannot cope at least once a week, 23 per cent of GPs say they're unlikely to be working in general practice in five years' time, and 72 per cent of GPs say they expect working in general practice to get worse in the next five years. So, I think what this is signalling is that there's a real disaffection and concern over their working habits amongst the GP profession. So, whilst it is very welcome that you've managed to fill all the places you have available, that we've recruited in some of the traditionally hard-to-recruit areas, I just wanted to have a clear understanding of your long-term strategy to turn around this situation to retain the GPs we have, to improve their conditions in such a way that we aren't having this potential threat of people leaving. 

Finally, I do remain concerned that gaps remain in a lot of the diagnostic workforce across the board and I just wondered if you could provide an update on Health Education and Improvement Wales's workforce strategy and how it specifically plans to address the gaps in the diagnostic workforce. I'm sure we all agree that, if we can diagnose people earlier, we can probably get to them, have better outcomes in terms of health and less cost to the country. What are you doing to increase clinical training places in line with present and future patient needs? And—this is an ask, actually, from some of the cancer charities—will the Welsh Government commit to a comprehensive audit of diagnostic staff numbers in the Welsh NHS? When I took a look at that situation, I thought that actually wasn't an altogether unreasonable ask and I wonder if HEIW might be addressing that. Thank you.

Thank you for the series of questions. I think some of that was slightly outside of where we are with 'Train. Work. Live.', but I'll do my best to respond to the points today and I'm pretty sure that, with debates on nursing tomorrow and potentially in the future, there will be plenty of opportunities to talk about workforce.

On male nursing, we won't have the figures until at least the end of this year and into next year to see if there's a trend, and, interestingly, this is an issue of concern both to the Royal College of Nursing and, indeed, Unison as well, where they've had particular issues about wanting to see nursing as a career for men, because the traditional images of nurses are women and then, for all the Charlie Fairheads, there are lots of others in terms of our regular depiction of the nursing workforce. So, there is a challenge there, and, as you say, it was a deliberate choice to pick a male nurse to head up the recruitment campaign last year, but I think it would be an unfair challenge to set to say that there should be a significant turnaround within one year, because we're dealing with a cultural turnaround to be required, but it's important we're deliberately trying to address it.

And, again, in terms of your point about learning from the Scots and attracting people to careers in the NHS, I'm happy to take good ideas from where they come from. If they're effective, I'm interested in how we could adapt and adopt them here in Wales rather than to try to point out how and why they couldn't work. And ideas that work within the context of the UK family of nations are much more likely to be adapted and adopted within Wales because of the similarities within our systems. So, I genuinely remain curious and interested in what other UK nations are doing in the face of broadly similar challenges. We should also have more information at the end of this year on some of the information on the return to nursing work and the trends that we see. So, there's a challenge in understanding what we do so that people return to a career in the NHS if they've left, but also how we retain some of those people who would otherwise leave, and that is something about some of the working patterns that we have. It's also something about the flexibility we want to see in the workforce as well, because some people may want to carry on working on a part-time basis. Now, what I don't want to do is to get into an artificial exercise of saying, 'Well, even though our nursing numbers have gone up by a net amount, when you think about it, it's gone up by more because we've kept people in who would otherwise have gone.' I don't think that's very helpful. But I do want to be able to set out how much more could we do with the flexibility we want to offer to keep people in the national health service, regardless of whether they are porters, admin workers or nurses or otherwise.

On the agency spend, look, part of this is the reality of wanting to roll out the legislation that we have done, when you think about wanting to have adequate staffing across the workforce, the ability to flex and deliver that, particularly with the challenges we've had with recruitment—. Because we can't ignore the reality that about 90 per cent of nurses who were otherwise registering on the NMC who registered in Europe are no longer coming. That puts big pressure on the nursing workforce we've already got. We know, within the western world more generally, there is pressure on nursing numbers. So, actually, regularising our ability to recruit and retain nurses from Europe is a big part of what we want to do, as well as international recruitment as well. But that is in the hands of the voters and others in the coming weeks about what our future relationship will be. But the significant investment in nurse training is to make it clear it's not just about recruiting from other people's countries, it is, actually, about training our own, who are much more likely to stay. Because nurses who go into the workforce tend to already have responsibilities and ties to an area, and that is not the same in other parts of the recently graduated workforce.

In terms of your point about the diagnostic workforce, you can expect to see some of that within the joint workforce strategy, but I think you'll see more of that as I come back to talk not just about the cancer workforce but more specifically about diagnostics as an area. In terms of retaining our existing GPs, we've got a range of work that I've regularly spoken about on reforming the contract, on the work on resolving indemnity in the short Bill that is in front of the Assembly right now. The challenge is on wanting to recruit people in and it to be done successfully, and a big part of it is actually about having more training practices. And that is something that GPs have told me, and HEIW themselves, would help them to want to sign up to stay within the health service system as well, within the national health service.

In terms of the reform agenda, though, it's important that they're able to see something's being done to general practice, because lots of that reform is being driven by people in the service. At the national primary care conference, one of the most impressive parts of it was to look at the cluster handbook that has been provided, where each cluster talks about what it is choosing to do and the leadership from general practice, working with others. And it's not because I have told them specifically what they should do—there's much greater ownership and ideas and innovation that's coming together. When I met the cluster leads in two particular meetings, I was really impressed by some of the enthusiasm to own some of the challenges and to come up with answers from them. Because, as you and I know, sadly, it's the case that, whatever speeches I may make, people don't always believe that a politician is the person they should listen to on how they should improve their job within the service. They are prepared to listen to their peers who are delivering the future already. And that is the encouraging part: the future's here already in other parts of the system here in Wales. Our challenge is how we share that and deliver that more consistently. But I look forward to being able to do that.

Thank you, Dirprwy Lywydd, and I'd also like to thank the Minister for his statement and for the advance copy. It is very welcome that there is clearly some positive news.

I'd like to ask the Minister some specific questions—none that don't relate to matters raised in his statement, but, if there are some that are too specific to be dealt with in this format, perhaps the Minister could write to me with the detail if I'm drilling down too far.

I want to ask, first of all, about what specific evaluation is being done of the effect of the campaign itself. You can sort of see the effect of the campaign in increased recruitment, but is the Minister undertaking any specific work to sort out whether—is it the campaign, is it a combination, as I suspect it might be, of the campaign and some other factors? I have to say it appears to me that it certainly is being effective, but there's obviously a considerable investment being made, and it would be useful to know what evaluation the Minister and his officials were undertaking about the specific impact of the campaign itself.

The Minister talks in his statement about the percentage increase in nursing, midwifery and physiotherapy training places, and all of those, of course, are very welcome. Now, I wonder if the Minister can tell us today how confident he is that this increase in places is going to meet the future need. I appreciate that some of this may come into the work that's being done by Health Education and Improvement Wales and Social Care Wales around workforce strategy, but a raw increase in training placements, if we're not sure that those are linked both to the present need and the future need, might, of course, risk us training that workforce and members of that workforce then having to go elsewhere to look for work if the roles are not there for them.

The cross-party group on stroke today heard that there are no doctors currently in higher training places in stroke services today. Now, I'm basing my question, of course, on what they say, and it may be that that information is out of date, but, obviously, if that is the case, it puts a huge strain on stroke care service delivery, and I wonder if the Minister can look into this situation and find out if it is the case and what steps he can take to rectify this particular issue.

The Minister's statement refers to recruitment to core psychiatry training going up from 33 per cent to 100 per cent. Again, of course, that's good news, but 30 per cent of what to 100 per cent of what? I wonder if the Minister would be prepared to share with us what the raw data is so that we can see the actual numbers of people in training. I also wonder if he has any information about the training places for clinical psychologists and whether we are successful in filling those places, and, again, whether they specifically meet the need.

The Minister's statement makes reference to work experience, and I wonder if the Minister accepts the findings from the Medical Schools Council project on widening access that teachers' and key influencers' first port of call for advice and guidance for medical school applications and that, sometimes, their knowledge of admissions, the role of the doctor, et cetera, can be patchy and not up to date—. And I wonder if the Minister would be prepared to have some further conversations with the Minister for Education about how we can ensure—again, the statement does have some positive things to say about this—that schools are able to give accurate advice to young people who may be considering careers in the health service more broadly. I'm particularly thinking that assumptions are not made about the appropriateness of children from less prosperous backgrounds, less prosperous areas, applying for medical training.

There's a very specific point about the national workforce reporting system to capture staff information in general practice. That's obviously an extremely sensible way to proceed, but Angela Burns has already mentioned the pressures on GP practices, and I wonder what the Minister and his officials are able to do to ensure that the collecting of this information doesn't put another additional burden on GP practices. I should be clear that I very much support the information being collected. What information is he sharing with GP practices so that people understand why the information is important, because it's certainly the case that people are much more likely to collect and report regularly on statistics if they know what we're going to do with them? Clearly, it's vital for workforce planning.

Just finally, Deputy Presiding Officer, the Minister talks about retention in his statement, and he mentioned it again in some of his responses to Angela Burns. This is obviously crucial, because the last thing we want to do is to train staff and then lose them. So, I wonder if the Minister can tell us whether he's confident today that we will have the new workforce strategy that will address this in detail shortly. There's been some delay. We'd all want to say it's much better to take more time and do the work properly, but it would be good to be reassured that that's going to happen. And on this day, international day of disabled people, the Minister will be very aware that we lose a lot of staff from the NHS because of disabilities that they acquire during their service in the NHS. Can he reassure us that the issues relating to retention in the workforce strategy will specifically address that issue and, if we have, perhaps, a nurse who's been working in a very physically demanding environment, how confident are we that local health boards are taking the appropriate steps to find alternative work that uses those skills so that we don't lose those very skilled professionals? Thank you.

On the final point, I had some interaction with the health service before I came to this place, both as a patient but also as a professional, and lots of that was actually—not just within the health service, but on a wide range of areas in the public sector and the private sector—on the business of making reasonable adjustments, to see the continuing value in staff, regardless of their mental or physical health, but to actually see what they can do, and to see that as a real benefit and not to lose sight of the experience of those people.

The most successful part of that was not actually winning a claim in a tribunal; it was actually when you were able to change the nature of the relationship in someone's workplace so that they could stay in work, rather than winning a sum of money once they had left the workplace, or running a claim against their employer to a successful conclusion that often led to the end of the workplace relationship in practical terms. I expect the health service to be absolutely part of that. I think that there's a broader point about retaining our staff—and the terms may change, the hours they work may change, the pattern may change—which is to want to start from the position that we want to retain the staff within the service.

On the point about the campaign, 'Train. Work. Live.' has a £0.5 million budget. The incentives are a bit over £400,000—the financial incentives for the medical training including general practice. Actually, I'll be publishing some information on the numbers of people that we think have been drawn into Wales as a result of the marketing campaign, but some of that will be about the combination of factors that you rightly point out. I want to understand the continuing value of the campaign, and part of the challenge is in delivering and understanding what a marketing campaign delivers and, if you take it away, what we think will happen as well.

But, I can honestly say, in each of the events that I have been to at the RCN congress in the last three years, and at the RCM conference, it is hard to overstate the enthusiasm, both from our own delegates at those conferences—. So, actually, our Welsh nurses and midwives are really proud to see Wales on centre stage, and they themselves are real advocates of people to want to come to work in Wales. But, the real enthusiasm from a range of other people about finding out what are the opportunities—. It's not just about turning up to look at a flashy stand and get a free Welsh cake. The level of interest that comes, with the single point of access to go back to people—. It's got better each year. So, it does show real value in what we're doing, and there's a consistent national brand, then, that is actually helping health boards to undertake their own recruitment activity too. So, there's real value. I want to try and understand that properly, and I want to give Assembly Members more detail of that over the next year or so.

In terms of future needs—and this links both to the workforce strategy point that you made and the consultation that has been put out by HEIW and Social Care Wales—this links back to the deliberate reform that we are undertaking of health and social care services in 'A Healthier Wales' and in wanting to understand how training takes place. So, how people are trained to train them for the world of work that they are going to go into, not the world of work that existed 10 years ago; but, more than that, the numbers that we'll need as well. So, it partly links into the workforce strategy. It also partly links into the deliberate reshaping that's going to take place.

The frameworks that we've undertaken for healthcare science and also allied health professionals talk about a wider role for that group of staff. That isn't just then about the staff that we have now. It is about deliberately wanting to reshape the balance in the numbers that we have. Some of this is not just about what we want in the future. It's about our ability to recruit. I don't mean that we don't have people who are capable of providing high-quality training and education for those people within the system here in Wales. It's actually about the fact that lots of that training has to take place within the health service.

In previous conversations that I've had with people on a cross-party basis—for example, about nurse training in Wrexham—one of the biggest limiting steps is actually about the capacity of the health service to have those training places available. So, it's about the capacity of our system to be able to deliver that, and I have chosen the maximalist option in each of the years that I've made that choice, bearing in mind the capacity of the system to adequately and properly train those people, given the experience of training that they should want and need, so that they have a good experience, a decent qualification and want to stay within the system here in Wales.

I will happily write back to the cross-party group on stroke on the specific issue that you raise. It may be helpful if the Chair, whom I recognise is in the room, writes to me with a specific question, and I'll happily come back. On psychiatry places, we have filled 21 out of 21 places. On the issues about teaching and encouraging people to consider a career in the health service, actually, when you talk to professional bodies and to trade unions within the health service, they say that their biggest worry about people choosing not to go into the health service is the way that the health service is regularly portrayed. They worry about the front pages on newspapers, in particular—but online sites as well—that talk about the health service, and people think, 'Well, I don't need to go there to earn a decent living, and why would I do that if I'm then going to get pilloried?' So there's a challenge there about how we talk about the service, and, to be clear, this isn't just an issue in Wales—it is a UK-wide issue, and it's about how we have an honest conversation about the service that doesn't put people off. But there is then, of course, wanting to encourage people to operate to the maximum of their ability. We talk about that in prudent healthcare terms, we talk about that with young people as well. I still take the view, from my old days in NUS Wales—and I'll finish on this point; no, I have one more point—. I'll write to you about the workforce tool, and to Members, because I think there's some detail there I can helpfully provide, but it is part of the GP contract agreed this year. It's a mandatory part, and the tool will be available for practices, clusters and health boards, too. But I'll provide some more detail.

But on this point about careers in the service, by the time people get to years 12 and 13, lower and upper sixth in old money, if you remember that, most people will have made choices already, even if they haven't consciously. So, actually, it's about a much earlier point in time before children leave primary school and at the start of high school, to remind them that they're good enough and they should think about a career, and to have a broader avenue and lookout on the world and what they're capable of. Because that will give us an even wider group of people, and it's why the widening access work that I referred to in my statement is so important, to make sure we have doctors who are like the people they're going to treat and serve in the future.

The Minister will be aware that I met with Gelligaer practice to discuss the closure of Gilfach surgery, and one of the issues they raised was that it wasn't just a shortage of GPs in the area that was causing them to struggle with the Government's approach to the primary care model, but also a shortage of other professionals in mental health, paramedics, and the rest. Therefore this campaign—and I think you've said that you wish to expand it into a recruitment campaign for all kinds of professionals, including nurses and pharmacists—is welcome. The question I'd simply put is: does the Minister believe that this campaign will lead to the easier fulfilment of the primary care approach that he is pioneering, and does he believe that GPs are engaging fully with that approach?

I think it's an important question because there's something about our ability to say, 'This is the right sort of way to work in the future'. There's broad sign-up to that, and then our ability to have the right numbers of staff in the right place to deliver that care. That is a challenge because, if you look back to three years ago and then five years ago, I think there would be a wider level of cynicism, it's fair to say, within many of our front-line members of staff, including in general practice, about the approach the Government set out. At the start of cluster working it was certainly not universally welcomed, and actually, now, from the primary care conference and, more than that, from my regular interaction, not just with representative bodies like the BMA and the Royal College of General Practitioners, but from my regular interaction going around and about the country, there is a much more positive view about clusters and their potential and their ability to deliver.

But it isn't even-handed. There are still some parts of the country that are a bit more reluctant than others, and part of what I want to do is to get to the position where actually people recognise that it's a better way of working and they're missing out if they don't do it. That means we need the right numbers of staff. On paramedics, for example, we do have more paramedics—there's been over a 7 per cent increase in the paramedic workforce within the last few years. Not only that, though, but we're investing in the skills of paramedics as well. So, the more advanced practice paramedics, who are not just useful within the emergency system but actually within primary care as well, we're finding a way for them to work so they don't need to give up one to do the other. That's been a real success story.

If you remember Bryntirion, they managed to find a model that did that, and it did exactly that, and it provided more stability within the workforce in doing so. If you look at the success, for example, of our first contact physiotherapy approach as well, we do see success in different parts of the country. It's still part of my frustration, and a challenge for the whole system, to see that more evenly distributed. I recognise the Member has a particular challenge in one part of the constituency, but I think people should take more confidence. We're putting our money where our mouth is and investing in the future of the workforce, and we will help and support people to deliver the new primary care model, because I am absolutely convinced it delivers better care for people and it's actually a better place for our staff to work.

Thank you for your statement, Minister. NHS staff are our most important resource. Pumping millions of pounds extra into healthcare is to no avail unless we have the doctors, nurses, radiographers, lab technicians and healthcare assistants needed to deliver first-class care. I welcome the progress the 'Train. Work. Live.' campaign is making, and the fact that you have managed to exceed the training places for GPs in every training scheme across Wales is great news. I welcome the increases in training places in nursing, radiography and physiotherapy also. It’s great to see that we are finally making progress.

However, praise aside, Minister, it’s still not enough. Four years ago, the Royal College of General Practitioners told us that we needed to train 200 GPs a year in order to stand still, and we are seeing record numbers of GPs leaving the profession. So, Minister, how many GPs will be trained and recruited next year? That's my first question.

The BMA recently highlighted an issue whereby local health boards across Wales are preventing expansion of GP premises across Wales—expansion that's necessary to provide consulting space for GP trainees. Minister, what assessment have you made of the impact this is having on the campaign to train and recruit more GPs in Wales, please?

If we are to train more staff, we also have to ensure that they want to stay in Wales once they're qualified. Nearly three quarters of Wales’s GPs say they expected the work in general practice to get worse over the next five years. So, Minister, how will the GP recruitment campaign address this fact and the shocking fact that a quarter of current GPs don’t expect to be working in general practice?

And finally, Minister, you have introduced an all-Wales locum register. Will locums on the English register be required to join the Welsh register, and will the Welsh register allow locums from border regions in Wales to work on both sides of Offa’s Dyke? We need to do so much more if we are to avoid the collapse of primary care in Wales, and I look forward to working with you, Minister. Thank you. 

Thank you for the questions. In terms of next year's GP training numbers, I've set a baseline of 160, and as I indicated in my statement, my intention is to be able to progressively raise the number of GP training places that we will have available to want to fill as our new baseline. However, that does depend on our ability to have the requisite number of training places in practices. So, I'm looking forward to some advice from Health Education and Improvement Wales about our ability within the system to progressively increase and successfully recruit to those numbers.

In terms of the specific issue you raised about the primary care estate, I'm not aware of the specific issue that you raise where a health board is preventing people from expanding provision, because we should remember that there's a balance here, isn't there? Because general practice is largely provided by independent contractors, some of whom own their own buildings, some of whom have a partnership with a range of other services to work from particular premises. And so, in investing in the primary care estate, we're more and more looking to invest in a combination of those, and to understand that, in the past, when we were helping to build facilities that the NHS didn't own, that brought different challenges too. So, that is partly about the partnership model and what happens. These are real practical issues that are part of our conversation with the general practice committee of the BMA. But, on the provision of a new generation of centres, the primary care pipeline, 19 individual schemes, including the recent good news that we had that the Mountain Ash scheme is on site now. So, we are actually delivering a newer range of premises already.

In terms of the issue about keeping current GPs, I'll try to deal with that in terms of the questions that Angela Burns asked. I didn't get to it in terms of the list of questions, but in terms of the points about the incentive schemes, that's important for keeping current GPs in practice as well, so they don't feel that there's no supply for future general practice as well. But we are looking to review the impact of those incentives, not just in the areas that have got incentives for what have been hard-to-recruit-to areas, but also to look to see if there's been an impact on surrounding general practice schemes. This year, that would appear not to be the case, because we filled every scheme. But as we said, a new baseline for each of those training schemes, I want to see what the direct impact is. 

In terms of the locum register, look, I think this is really important for us to understand where and how many locums we have and the terms on which they're engaged. And part of the deal in the new contract that we've agreed with the general practice committee of the BMA is actually about how we incentivise people to come off the locum way of working and to become either salaried or, indeed, partners in general practice as well, and to provide us with the stability that we'd want. And there's a generational challenge there as well, which is, honest, not just within the health service but on a much wider basis, about how we help people to look at what's on offer within the NHS and to understand what's on offer, and they commit to that career, whether as a primary care contractor or otherwise, and then the register should help us to do that and to be much clearer about the terms on which people are engaged. 

Thank you very much, Minister.